Std syndromic approach psm
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syndromic management sexually transmitted infections
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India NACO syndromic case management STI RTI colour coded kits guidelines
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https://naco.mohfw.gov.in/files/National%20Technical%20Guide…
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https://naco.mohfw.gov.in/files/National%20Technical%20Guide…
Syndromic approach for STI/RTI - PSM
Definition:
Syndromic case management is the diagnosis and treatment of STI/RTI based on a group of symptoms and signs (syndrome), using standard flowcharts, without waiting for laboratory confirmation. It gives treatment for all likely causative organisms, since mixed infections are common.
Syndromic case management is the diagnosis and treatment of STI/RTI based on a group of symptoms and signs (syndrome), using standard flowcharts, without waiting for laboratory confirmation. It gives treatment for all likely causative organisms, since mixed infections are common.
WHO has recommended it since 1990, particularly where laboratory facilities are unavailable or delayed. - Park's Textbook of Preventive and Social Medicine, p. 381.
Common STI/RTI syndromes
- Urethral discharge in men
- Vaginal/cervical discharge
- Genital ulcer disease - herpetic or non-herpetic
- Lower abdominal pain / pelvic inflammatory disease (PID)
- Painful scrotal swelling
- Inguinal bubo
- Anorectal discharge / proctitis
Steps in syndromic case management
- Take focused history and perform examination.
- Identify the syndrome from the NACO flowchart.
- Rule out emergencies or non-STI causes and refer if needed.
- Give treatment immediately using the appropriate colour-coded kit.
- Counsel on adherence, abstinence until treatment is completed and symptoms resolve, and condom use.
- Notify, counsel, and treat sexual partner(s).
- Offer HIV and syphilis testing, and assess for hepatitis B/C where indicated.
- Ask the patient to return if symptoms persist or recur, and arrange follow-up.
Partner notification and treatment are particularly important in urethral discharge because women partners may have asymptomatic gonococcal or chlamydial infection. - Park's Textbook of Preventive and Social Medicine, p. 381.
NACO colour-coded STI/RTI kits, 2024
| Kit | Colour | Drugs | Main indication |
|---|---|---|---|
| 1 | Grey | Azithromycin 1 g + cefixime 800 mg, single dose | Urethral discharge, cervicitis, painful scrotal swelling, presumptive treatment |
| 2 | Green | Secnidazole 2 g + fluconazole 150 mg, single dose | Vaginal discharge due to vaginitis |
| 3 | White | Benzathine penicillin G 2.4 million units IM + azithromycin 1 g | Non-herpetic genital ulcer: syphilis/chancroid |
| 4 | Blue | Doxycycline 100 mg twice daily for 14 days + azithromycin 1 g | Non-herpetic genital ulcer if benzathine penicillin unavailable or allergy history |
| 5 | Red | Acyclovir 400 mg three times daily for 7 days | Herpetic genital ulcer |
| 6 | Yellow | Cefixime 800 mg single dose + metronidazole 400 mg twice daily for 14 days + doxycycline 100 mg twice daily for 14 days | Lower abdominal pain / PID |
| 7 | Black | Doxycycline 100 mg twice daily for 21 days | Inguinal bubo due to LGV; LGV proctitis |
| 8 | Brown | Cefixime 800 mg single dose + doxycycline 100 mg twice daily for 7 days | Anorectal discharge syndrome |
This is based on the current NACO STI/RTI technical guideline. Older PSM notes may list only Kits 1-7.
Advantages
- Immediate treatment in the first visit
- No dependency on laboratory tests
- Simple standardized flowcharts
- Treats mixed infections empirically
- Useful at peripheral and resource-limited facilities
- Helps reduce complications and onward HIV/STI transmission
- Facilitates partner treatment
Limitations
- Less accurate than etiological diagnosis
- Can cause overtreatment and unnecessary antibiotic use
- Cannot detect many asymptomatic infections
- Vaginal discharge is less specific for cervical STIs
- Does not replace laboratory testing where tests are available, especially in persistent, recurrent, severe, pregnant, or complicated cases
One-line exam answer:
Syndromic management is a standardized, flowchart-based method of treating STI/RTI patients immediately according to recognized clinical syndromes, covering the most likely organisms and including counselling, partner treatment, condom promotion, HIV/syphilis testing, and follow-up.
Syndromic management is a standardized, flowchart-based method of treating STI/RTI patients immediately according to recognized clinical syndromes, covering the most likely organisms and including counselling, partner treatment, condom promotion, HIV/syphilis testing, and follow-up.
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